The Clinical and Economic Impact of Penicillin Allergy

青霉素过敏的临床和经济影响

基本信息

批准号：
9921287
负责人：
Kimberly Gold Blumenthal
金额：
$ 13.72万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-22 至 2021-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9921287
关键词：
Accident and Emergency department Address Allergic Allergic Reaction Antibiotic Resistance Antibiotics Antimicrobial Resistance Bioinformatics Biometry Cephalosporins Chiroptera Clinical Clinical Immunology Clostridium difficile Code Colitis Communicable Diseases Complement Cost Effectiveness Analysis Data Databases Doctor of Medicine Doctor of Philosophy Dose Drug Hypersensitivity Economic Burden Economics Educational workshop Electronic Health Record Ensure Environment Epidemiology Evaluation Frequencies Funding General Hospitals Goals HIV Health Health Policy Healthcare Healthcare Systems Hypersensitivity Hypersensitivity skin testing Immune Immunology Infection Infection Control Inpatients Intensive Care Units Internal Medicine International Intervention Investigation Journals K-Series Research Career Programs Knowledge Lead Literature London Manuscripts Massachusetts Master of Science Mediating Medical Medicine Mentors Mentorship Methods Modeling Monobactams Morbidity - disease rate National Institute of Allergy and Infectious Disease Outcome Outcomes Research Outpatients Patient Care Patient Self-Report Patient-Focused Outcomes Patients Peer Review Penicillin Allergy Penicillins Perioperative Pharmaceutical Preparations Phenotype Physician Executives Policies Population Positioning Attribute Prevalence Public Health Public Health Schools Publications Reaction Recording of previous events Reporting Research Research Personnel Research Proposals Research Training Resistance Resources Risk Safety Schools Science Surgical Wound Infection Testing Text Training Training Activity United States National Institutes of Health Universities Untranslated RNA Work adverse drug reaction beta-Lactams care costs career clinical epidemiology cohort combat cost cost effective cost effectiveness design economic impact electronic data epidemiology study genetic linkage analysis health care quality healthcare-associated infections improved instructor medical schools models and simulation mortality multidisciplinary programs simulation skills success undergraduate student

Accident and Emergency department Address Allergic Allergic Reaction Antibiotic Resistance Antibiotics Antimicrobial Resistance Bioinformatics Biometry Cephalosporins Chiroptera Clinical Clinical Immunology Clostridium difficile Code Colitis Communicable Diseases Complement Cost Effectiveness Analysis Data Databases Doctor of Medicine Doctor of Philosophy Dose Drug Hypersensitivity Economic Burden Economics Educational workshop Electronic Health Record Ensure Environment Epidemiology Evaluation Frequencies Funding General Hospitals Goals HIV Health Health Policy Healthcare Healthcare Systems Hypersensitivity Hypersensitivity skin testing Immune Immunology Infection Infection Control Inpatients Intensive Care Units Internal Medicine International Intervention Investigation Journals K-Series Research Career Programs Knowledge Lead Literature London Manuscripts Massachusetts Master of Science Mediating Medical Medicine Mentors Mentorship Methods Modeling Monobactams Morbidity - disease rate National Institute of Allergy and Infectious Disease Outcome Outcomes Research Outpatients Patient Care Patient Self-Report Patient-Focused Outcomes Patients Peer Review Penicillin Allergy Penicillins Perioperative Pharmaceutical Preparations Phenotype Physician Executives Policies Population Positioning Attribute Prevalence Public Health Public Health Schools Publications Reaction Recording of previous events Reporting Research Research Personnel Research Proposals Research Training Resistance Resources Risk Safety Schools Science Surgical Wound Infection Testing Text Training Training Activity United States National Institutes of Health Universities Untranslated RNA Work adverse drug reaction beta-Lactams care costs career clinical epidemiology cohort combat cost cost effective cost effectiveness design economic impact electronic data epidemiology study genetic linkage analysis health care quality healthcare-associated infections improved instructor medical schools models and simulation mortality multidisciplinary programs simulation skills success undergraduate student

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项目摘要

Project Summary Candidate Kimberly G. Blumenthal, MD is an Assistant in Medicine in the Allergy and Clinical Immunology Unit at Massachusetts General Hospital (MGH) and an Instructor of Medicine at Harvard Medical School (HMS). After her undergraduate training in economics at Columbia University and the London School of Economics, she received her M.D. from Yale University. Dr. Blumenthal began working with Rochelle P. Walensky, MD, MPH and the Medical Practice Evaluation Center (MPEC) at MGH after completion of her clinical training at MGH in Internal Medicine and Allergy/Immunology. Dr. Blumenthal studies drug allergy epidemiology and impact on patient care; she has authored 13 total manuscripts, with 7 first-authored peer-reviewed manuscripts, including publications in the Journal of Allergy and Clinical Immunology and Clinical Infectious Diseases. Dr. Blumenthal is completing a Masters of Science in Epidemiology at the Harvard T.H. Chan School of Public Health. Dr. Blumenthal's goal is to become a national leader in drug allergy with methods expertise in clinical epidemiology and decision science. Mentorship, Training Activities, and Environment Dr. Blumenthal will perform the work outlined in this proposal at MGH under the mentorship of Rochelle P. Walensky, MD, MPH and co-mentorship of Aleena Banerji, MD. Dr. Walensky, Co-director of MPEC, is a nationally-recognized expert in decision science whose research has motivated national and international policies related to testing and treatment of Human Immunodeficiency Virus. Dr. Walensky has been NIH-funded since 2006; she has served as a mentor to over 5 prior K awardees, and has successfully transitioned fellows to independent R01-funded research careers. Dr. Banerji is a nationally-recognized expert in drug allergy with expertise in epidemiology and outcomes research. Dr. Blumenthal's research will benefit from the specific expertise of collaborators: Carlos A. Camargo, MD, DrPH (epidemiology), Robert A. Parker, ScD (biostatistics), Stephen Resch, PhD (resource utilization), Li Zhou, MD, PhD (bioinformatics) and Erica S. Shenoy, MD, PhD (infection control). Dr. Blumenthal has organized a Scientific Advisory Board, chaired by Dr. Camargo, that includes: Andrew D. Luster, MD, PhD, Katrina A. Armstrong, MD, MSCE and David W. Bates, MD, MSc. To complement the expertise of her mentors, collaborators and advisors, Dr. Blumenthal will complete didactic courses to acquire new research skills, including linkage and analysis of large databases, resource utilization analysis and simulation modeling and cost-effectiveness analysis. The collaborative opportunities, intellectual environment, and resources available to Dr. Blumenthal are outstanding and will provide her with a clear path to independent research success. Research Penicillin (PCN) allergy is reported by over 10% of the U.S. population, though a self-reported PCN allergy infrequently reflects an actual inability to tolerate PCNs and other β-lactam antibiotics (e.g., cephalosporins). Unnecessary use of β-lactam alternative antibiotics may lead to more antimicrobial resistance and healthcare-associated infections, as well as higher costs. Although the prevalence of self-reported PCN allergy does not equate with true PCN hypersensitivity, PCNs and other β-lactam antibiotics are the most common cause of drug hypersensitivity reactions, the immune-mediated subset of adverse drug reactions (ADRs). ADRs have a large impact on patient morbidity, mortality and cost of care. PCN allergy evaluation with skin testing can distinguish between patients with and without true PCN hypersensitivity. Implementation of a history-appropriate PCN skin testing may improve clinical outcomes and the efficiency of resource use. The K01 scientific program, The Clinical and Economic Impact of Penicillin Allergy, has three specific aims that lie at the research intersection of Allergy/Immunology, Infectious Diseases and healthcare policy, and align with national priorities including curbing antimicrobial resistance and improving healthcare quality and safety: 1) To assess the clinical and economic impact of reported PCN allergy in a large U.S. healthcare system using a large patient cohort combined from separate internal databases. 2) To determine the frequency, predictors and healthcare resource impact of PCN and cephalosporin hypersensitivity reactions in the outpatient setting using an internal cohort of patients prescribed PCNs or cephalosporins over a 10-year period. 3) To project the clinical outcomes, budgetary impact and cost-effectiveness of implementing a PCN skin testing program in the U.S. using a simulation model. Completion of this research proposal and training plan will position Dr. Blumenthal for an independent research career as a drug allergy expert with methods skills in clinical epidemiology and decision science.

项目摘要候选人金伯利G. Blumenthal，医学博士是过敏和临床免疫学部门的医学助理在马萨诸塞州综合医院（MGH）和哈佛医学院（HMS）的医学讲师。在她在哥伦比亚大学和伦敦经济学院的经济学培训后，她从耶鲁大学获得了医学博士学位。 Blumenthal博士开始与Rochelle P. Walensky，医学博士合作 MGH和医疗实践评估中心（MPEC）在MGH完成后完成临床培训后内科和过敏/免疫学的MGH。 Blumenthal博士研究药物过敏流行病学和对患者护理的影响；她撰写了13份手稿，并进行了7次经过撰稿的同行评审手稿，包括过敏和临床免疫学杂志上的出版物以及临床感染性疾病。 Blumenthal博士正在哈佛T.H.完成流行病学科学硕士学位。陈公共卫生学院。 Blumenthal博士的目标是通过方法成为毒品过敏的国家领导者临床流行病学和决策科学方面的专业知识。 Blumenthal博士将执行指导，培训活动和环境 MGH的提案在马里兰州Rochelle P. Walensky的心态下，MPH和Aleena的冠军医学博士Banerji。 MPEC联合主任Walensky博士是一项全国认可的决策科学经验研究已经成熟了与人类测试和治疗有关的国家和国际政策免疫缺陷病毒。自2006年以来，Walensky博士已获得NIH资助；她曾是5岁以上的精神先前的K获奖者，并成功地将同伴转移到了独立R01资助的研究职业。博士 Banerji是全国认可的药物过敏专家，具有流行病学和结果研究专家。 Blumenthal博士的研究将受益于合作者的具体专业知识：Carlos A. Camargo，医学博士， DRPH（流行病学），Robert A. Parker，SCD（生物统计学），Stephen Resch，PhD（资源利用率），Li Zhou，医学博士，博士（生物信息学）和医学博士Erica S. Shenoy（感染控制）。 Blumenthal博士有由Camargo博士主持的科学顾问委员会组织，其中包括：Andrew D. Luster，MD，PhD， MSCE医学博士Katrina A. Armstrong和MSC的David W. Bates。为了完成她的导师的专业知识，合作者和顾问，Blumenthal博士将完成教学课程，以获得新的研究技能，包括大型数据库的链接和分析，资源利用分析和仿真建模以及成本效益分析。可用的协作机会，智力环境和资源对Blumenthal博士来说，这是出色的，将为她提供独立研究成功的清晰途径。研究青霉素（PCN）过敏报告了超过10％的美国人群，尽管自我报告的PCN 过敏很少反映出耐受PCN和其他β-内酰胺抗生素的实际无法（例如，头孢菌素）。不必要的β-内酰胺替代抗生素可能会导致更大的抗菌耐药性以及与医疗保健相关的感染以及更高的成本。虽然自我报告的PCN的患病率过敏与真正的PCN超敏反应，PCN和其他β-内酰胺抗生素不等药物超敏反应的常见原因，免疫介导的广告药物反应子集（ADR）。 ADR对患者的发病率，死亡率和护理成本有很大影响。 PCN过敏评估皮肤测试可以区分有和没有真正PCN过敏的患者。实施适用于历史的PCN皮肤测试可以改善临床结果和资源使用效率。 K01科学计划是青霉素过敏的临床和经济影响，具有三个特定目标在过敏/免疫学，传染病和医疗保健政策的研究交集中，并与国家优先事项，包括遏制抗菌素耐药性以及改善医疗保健质量和安全性： 1）评估在美国大型医疗保健系统中报告的PCN过敏的临床和经济影响使用来自单独的内部数据库的大型患者队列。 2）确定PCN和头孢菌素的频率，预测因素和医疗资源的影响使用内部患者处方PCN或头孢菌素在10年内。 3）预测实施PCN皮肤的临床结果，预算影响和成本效益使用仿真模型在美国测试程序。该研究建议和培训计划的完成将使Blumenthal博士定位进行独立研究作为临床流行病学和决策科学方法技能的药物过敏专家的职业。